Orthopedic Coding Alert

These high-paying Botox^® injections treat several spinal conditions.

Patients your orthopedist treat for certain spinal injuries or conditions might require chemodenervation injections to alleviate pain and help with treatment.

Chemodenervation claims probably aren’t terribly familiar to some ortho coders, but you need to be ready to code when a chemodenervation claim hits your desk. You’ll need to choose the correct codes for the procedure, of course; but there’s also drug supply, additional services, and modifier questions to answer before you complete the claim.

Take a look at this chemodenervation Q&A so you aren’t thrown for a loop next time you need to code for one.

Q: What is chemodenervation?

A: According to Rachel Williams, COC, CPC, CRC, outpatient coding specialist in Cumming, Georgia, “chemodenervations are intramuscular injections of neurotoxins. The toxin acts by blocking release of acetylcholine

(a neurotransmitter) at the neuromuscular junction, thus reducing the tone of overactive muscles. The clinical goals for utilizing neurotoxin injections are to result in a temporary chemodenervation of the effected muscle at the neuromuscular junction thus: reducing pain or increasing comfort, improving function, preventing or treating musculoskeletal complications, facilitating ease of care, and/or for improving the general appearance, mobility and/or phonation.”

Q: What CPT^® codes represent chemodenervation?

The codes CPT^® lists for chemodenervation are:

• 64612 (Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm))
• 64615 (… muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine))
• 64616 (… neck muscle(s), excluding muscles of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis))
• 64617 (… larynx, unilateral, percutaneous (eg, for spasmodic dysphonia), includes guidance by needle electromyography, when performed)

While it’s possible that you could see any type of presentation in any medical setting, most ortho practices will only see patients that require chemodenervation represented by code 64616.

Q: Who might need chemodenervation in an ortho practice?

According to Williams, you can use chemodenervation codes to treat any of the following conditions:

• Cervical dystonia, also known as spasmodic torticollis.
• Multiple sclerosis.
• Paraplegia.
• Quadriplegia and quadriparesis.
• Sequela of spinal cord or traumatic brain injury (e.g. spasticity, intractable headache, etc.).

You’ll need to check with your individual insurers to see what diagnoses they will cover for chemodenervation, because they might differ among insurers. According to Palmetto GBA Local Coverage Determination (LCD) L33458, Chemodenervation techniques are indicated/covered for:

• “Chemodenervation of cervical spinal muscles in the management of spasmodic torticollis.
• Chemodenervation of extremity muscles in the management of dystonias, cerebral palsy, upper and lower limb spasticity (see Note:) and multiple sclerosis.”

Q: Can you report drug supply codes for chemodenervation?

A: It depends on the drug. “Injection of therapeutic medication — anesthetics, etc. — are bundled into these CPT^® codes,” reports Williams. “However, some separate drug supply codes may be reported with 64612–64617. The most common drug used for these procedures is OnabotulinumtoxinA^®, which is more prevalently known by its brand name, Botox^®.”

The J codes for Botox^® for use with chemodenervation codes are:

• J0585 (Injection, onabotulinumtoxinA, 1 unit)
• J0586 (Injection, abobotulinumtoxinA, 5 units)
• J0587 (Injection, rimabotulinumtoxinB, 100 units)
• J0588 (Injection, incobotulinumtoxinA, 1 unit)

Warning: Williams notes that Botox^® is frequently given in 100-unit does, which often results in some wastage. In order to convey the exact amount of Botox^® your provider used, be sure to bill for all units and append modifier JW (Drug amount discarded/not administered to any patient) to the J code to reflect any wastage. Also, be sure to specify the amount not used in the notes.

Q: Can I report any other service/supplies during chemodenervation?

A: Again, it depends. During chemodenervation procedures, “supplies such as needles, syringes, gauze etc. are not separately reportable,” relays Amy Turner, RN, BSN, MMHC, CPC, CHC, CHIAP, healthcare consultant in Brentwood, Tennessee.